Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy: A Multicenter International Ventricular Tachycardia Registry

Pasquale Santangeli, Roderick Tung, Yumei Xue, Fa Po Chung, Yenn Jiang Lin, Luigi Di Biase, Xianzhang Zhan, Chin Yu Lin, Wei Wei, Sanghamitra Mohanty, David J. Burkhardt, Erica S. Zado, David J. Callans, Francis E. Marchlinski, Shulin Wu, Shih Ann Chen, Andrea Natale

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: This study sought to determine the long-term outcomes of catheter ablation (CA) of ventricular tachycardia (VT) in a series of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) without background implantable cardioverter-defibrillator (ICD) therapy. Background: Endo-epicardial CA of VT has been demonstrated to be highly effective in reducing recurrent VT in patients with ARVC. Methods: Thirty-two patients (age 45 ± 13 years, 72% male) with ARVC and VT underwent CA in the absence of ICD therapy. ICD was recommended in all cases, but implantation was not performed due to patient refusal (63%) or financial hardship (37%). CA was guided by activation/entrainment mapping for mappable VT and pace mapping/targeting of abnormal substrate in cases of unmappable VT. Results: Symptoms associated with clinical VT included palpitations (78%), chest pain and shortness of breath (22%), pre-syncope (16%), and syncope (13%). Prior to ablation, 22 patients (69%) failed a mean of 1.3 ± 0.5 antiarrhythmic drugs. Epicardial mapping and ablation was performed as first-line strategy (20 [63%]) or in case of recurrent VT or persistent inducibility after endocardial-only ablation (3 [9%]—surgical epicardial cryoablation in 1 patient). After a mean of 1.6 (range 1 to 3) procedures, all patients demonstrated noninducibility of sustained VT from at least 2 RV sites; 75% also had stimulation on isoproterenol with no inducible VT. At a median follow-up of 46 months (range 26 to 65 months) following the last ablation, no deaths were observed and freedom from recurrent VT was 81%. Conclusions: In this multicenter international registry of patients with ARVC and VT, CA performed in the absence of background ICD was associated with a low rate of symptomatic VT recurrence (19%) without mortality during 46-month median follow-up. These data suggest that further prospective studies may refine selection of patients with structural heart disease at low risk for SCD, possibly obviating the benefit of ICD therapy.

Original languageEnglish (US)
Pages (from-to)55-65
Number of pages11
JournalJACC: Clinical Electrophysiology
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2019

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Arrhythmogenic Right Ventricular Dysplasia
Catheter Ablation
Implantable Defibrillators
Ventricular Tachycardia
Registries
Therapeutics
Syncope
Epicardial Mapping
Cryosurgery
Anti-Arrhythmia Agents
Chest Pain
Isoproterenol
Dyspnea
Patient Selection

Keywords

  • arrhythmogenic right ventricular cardiomyopathy
  • catheter ablation
  • long-term outcome
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy : A Multicenter International Ventricular Tachycardia Registry. / Santangeli, Pasquale; Tung, Roderick; Xue, Yumei; Chung, Fa Po; Lin, Yenn Jiang; Di Biase, Luigi; Zhan, Xianzhang; Lin, Chin Yu; Wei, Wei; Mohanty, Sanghamitra; Burkhardt, David J.; Zado, Erica S.; Callans, David J.; Marchlinski, Francis E.; Wu, Shulin; Chen, Shih Ann; Natale, Andrea.

In: JACC: Clinical Electrophysiology, Vol. 5, No. 1, 01.01.2019, p. 55-65.

Research output: Contribution to journalArticle

Santangeli, P, Tung, R, Xue, Y, Chung, FP, Lin, YJ, Di Biase, L, Zhan, X, Lin, CY, Wei, W, Mohanty, S, Burkhardt, DJ, Zado, ES, Callans, DJ, Marchlinski, FE, Wu, S, Chen, SA & Natale, A 2019, 'Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy: A Multicenter International Ventricular Tachycardia Registry', JACC: Clinical Electrophysiology, vol. 5, no. 1, pp. 55-65. https://doi.org/10.1016/j.jacep.2018.09.019
Santangeli, Pasquale ; Tung, Roderick ; Xue, Yumei ; Chung, Fa Po ; Lin, Yenn Jiang ; Di Biase, Luigi ; Zhan, Xianzhang ; Lin, Chin Yu ; Wei, Wei ; Mohanty, Sanghamitra ; Burkhardt, David J. ; Zado, Erica S. ; Callans, David J. ; Marchlinski, Francis E. ; Wu, Shulin ; Chen, Shih Ann ; Natale, Andrea. / Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy : A Multicenter International Ventricular Tachycardia Registry. In: JACC: Clinical Electrophysiology. 2019 ; Vol. 5, No. 1. pp. 55-65.
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abstract = "Objectives: This study sought to determine the long-term outcomes of catheter ablation (CA) of ventricular tachycardia (VT) in a series of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) without background implantable cardioverter-defibrillator (ICD) therapy. Background: Endo-epicardial CA of VT has been demonstrated to be highly effective in reducing recurrent VT in patients with ARVC. Methods: Thirty-two patients (age 45 ± 13 years, 72{\%} male) with ARVC and VT underwent CA in the absence of ICD therapy. ICD was recommended in all cases, but implantation was not performed due to patient refusal (63{\%}) or financial hardship (37{\%}). CA was guided by activation/entrainment mapping for mappable VT and pace mapping/targeting of abnormal substrate in cases of unmappable VT. Results: Symptoms associated with clinical VT included palpitations (78{\%}), chest pain and shortness of breath (22{\%}), pre-syncope (16{\%}), and syncope (13{\%}). Prior to ablation, 22 patients (69{\%}) failed a mean of 1.3 ± 0.5 antiarrhythmic drugs. Epicardial mapping and ablation was performed as first-line strategy (20 [63{\%}]) or in case of recurrent VT or persistent inducibility after endocardial-only ablation (3 [9{\%}]—surgical epicardial cryoablation in 1 patient). After a mean of 1.6 (range 1 to 3) procedures, all patients demonstrated noninducibility of sustained VT from at least 2 RV sites; 75{\%} also had stimulation on isoproterenol with no inducible VT. At a median follow-up of 46 months (range 26 to 65 months) following the last ablation, no deaths were observed and freedom from recurrent VT was 81{\%}. Conclusions: In this multicenter international registry of patients with ARVC and VT, CA performed in the absence of background ICD was associated with a low rate of symptomatic VT recurrence (19{\%}) without mortality during 46-month median follow-up. These data suggest that further prospective studies may refine selection of patients with structural heart disease at low risk for SCD, possibly obviating the benefit of ICD therapy.",
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author = "Pasquale Santangeli and Roderick Tung and Yumei Xue and Chung, {Fa Po} and Lin, {Yenn Jiang} and {Di Biase}, Luigi and Xianzhang Zhan and Lin, {Chin Yu} and Wei Wei and Sanghamitra Mohanty and Burkhardt, {David J.} and Zado, {Erica S.} and Callans, {David J.} and Marchlinski, {Francis E.} and Shulin Wu and Chen, {Shih Ann} and Andrea Natale",
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T1 - Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy

T2 - A Multicenter International Ventricular Tachycardia Registry

AU - Santangeli, Pasquale

AU - Tung, Roderick

AU - Xue, Yumei

AU - Chung, Fa Po

AU - Lin, Yenn Jiang

AU - Di Biase, Luigi

AU - Zhan, Xianzhang

AU - Lin, Chin Yu

AU - Wei, Wei

AU - Mohanty, Sanghamitra

AU - Burkhardt, David J.

AU - Zado, Erica S.

AU - Callans, David J.

AU - Marchlinski, Francis E.

AU - Wu, Shulin

AU - Chen, Shih Ann

AU - Natale, Andrea

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: This study sought to determine the long-term outcomes of catheter ablation (CA) of ventricular tachycardia (VT) in a series of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) without background implantable cardioverter-defibrillator (ICD) therapy. Background: Endo-epicardial CA of VT has been demonstrated to be highly effective in reducing recurrent VT in patients with ARVC. Methods: Thirty-two patients (age 45 ± 13 years, 72% male) with ARVC and VT underwent CA in the absence of ICD therapy. ICD was recommended in all cases, but implantation was not performed due to patient refusal (63%) or financial hardship (37%). CA was guided by activation/entrainment mapping for mappable VT and pace mapping/targeting of abnormal substrate in cases of unmappable VT. Results: Symptoms associated with clinical VT included palpitations (78%), chest pain and shortness of breath (22%), pre-syncope (16%), and syncope (13%). Prior to ablation, 22 patients (69%) failed a mean of 1.3 ± 0.5 antiarrhythmic drugs. Epicardial mapping and ablation was performed as first-line strategy (20 [63%]) or in case of recurrent VT or persistent inducibility after endocardial-only ablation (3 [9%]—surgical epicardial cryoablation in 1 patient). After a mean of 1.6 (range 1 to 3) procedures, all patients demonstrated noninducibility of sustained VT from at least 2 RV sites; 75% also had stimulation on isoproterenol with no inducible VT. At a median follow-up of 46 months (range 26 to 65 months) following the last ablation, no deaths were observed and freedom from recurrent VT was 81%. Conclusions: In this multicenter international registry of patients with ARVC and VT, CA performed in the absence of background ICD was associated with a low rate of symptomatic VT recurrence (19%) without mortality during 46-month median follow-up. These data suggest that further prospective studies may refine selection of patients with structural heart disease at low risk for SCD, possibly obviating the benefit of ICD therapy.

AB - Objectives: This study sought to determine the long-term outcomes of catheter ablation (CA) of ventricular tachycardia (VT) in a series of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) without background implantable cardioverter-defibrillator (ICD) therapy. Background: Endo-epicardial CA of VT has been demonstrated to be highly effective in reducing recurrent VT in patients with ARVC. Methods: Thirty-two patients (age 45 ± 13 years, 72% male) with ARVC and VT underwent CA in the absence of ICD therapy. ICD was recommended in all cases, but implantation was not performed due to patient refusal (63%) or financial hardship (37%). CA was guided by activation/entrainment mapping for mappable VT and pace mapping/targeting of abnormal substrate in cases of unmappable VT. Results: Symptoms associated with clinical VT included palpitations (78%), chest pain and shortness of breath (22%), pre-syncope (16%), and syncope (13%). Prior to ablation, 22 patients (69%) failed a mean of 1.3 ± 0.5 antiarrhythmic drugs. Epicardial mapping and ablation was performed as first-line strategy (20 [63%]) or in case of recurrent VT or persistent inducibility after endocardial-only ablation (3 [9%]—surgical epicardial cryoablation in 1 patient). After a mean of 1.6 (range 1 to 3) procedures, all patients demonstrated noninducibility of sustained VT from at least 2 RV sites; 75% also had stimulation on isoproterenol with no inducible VT. At a median follow-up of 46 months (range 26 to 65 months) following the last ablation, no deaths were observed and freedom from recurrent VT was 81%. Conclusions: In this multicenter international registry of patients with ARVC and VT, CA performed in the absence of background ICD was associated with a low rate of symptomatic VT recurrence (19%) without mortality during 46-month median follow-up. These data suggest that further prospective studies may refine selection of patients with structural heart disease at low risk for SCD, possibly obviating the benefit of ICD therapy.

KW - arrhythmogenic right ventricular cardiomyopathy

KW - catheter ablation

KW - long-term outcome

KW - ventricular tachycardia

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